Hyperthyroidism (Grave’s Disease)
2.
Overactivity and changes in the thyroid gland may be
present
3.
Most often seen in women between ages 30-50
4.
Cause unkown, but may be an autoimmune process
5.
Symptomatic, hperthyroidism may also be called
thyrotoxicosis
1.
Drug Therapy
a.
Antithyroid
drugs (propylthrouracil and methimazole ([Tapazole]): block synthesis of
thyroid hormone; toxic effects include agranulocytosis
b.
Adrenergic
blocking agents (commonly propanolol [Inderal]): used to decrease sympathetic
activity and alleviate systems such as tahycardia
2.
Radioactive
iodine therapy
a.
Radioactive
isotope of iodine (e.g., 131I) given to destroy the thyroid gland,
thereby decreasing production of thyroid hormone
b.
Used in
middle-aged or older clients who are resistant to, or develop toxicity from,
drug therapy
c.
Hypothyroidism is a potential complication
3.
Surgery: thyroidectomy performed
in younger clients for whom drug
therapy has not been effective
B. Assessment
findings
1.
Irritability,
agitation, restlessness, hyperactive movements, tremor, sweating, insomnia
2.
Increased appetite, hyperphagia, weight loss, diarrhea, intolerance to
heat
3.
Exophthalmos (protrusion of the eyeballs), goiter
4.
Warm, smooth skin; fine, soft hair; pliable nails
5.
Tachycardia, increased systolic blood
pressure, palpitations
6.
Diagnostic tests
a.
Serum T3 and T4 levels elevated
b.
RAIU increased
D. Nursing interventions
1.
Monitor vital signs, daily weights.
2.
Administer antithyroid medications as ordered.
3.
Provide for periods of uninterrupted rest.
a.
Assign to a private room away from excessive activity.
b.
Administer medications to promote sleep as ordered.
4.
Provide a cool environment
5.
Minimize stress in the environment
6.
Encourage quiet, relaxing diversional
Activities
7. Provide a diet high in carbohydrates,
protein, calories, vitamins, and minerals with supplemental feedings between
meals and at bedtime; omit stimulants
8. Observe for and prevent complications
a.
Exophthalmos: protect eyes
c.
Thyroid storr.
9.Provide client teaching and discharge planning
concerning
a.
Need to recognize and report signs and symptoms of agranulocytosis
(fever, sore throat, skin rash) if taking antithyroid drugs
b.
Signs and symptoms of hyper/hypothyroidism
Thyroid Storm
A. General information
1. Uncontrolled and
potentially life-threatening
hyperthyroidism caused by sudden and excessive release of thyroid
hormone into the blood stream
2.Precipitating factors: stress, infection, unprepared
thyroid surgery
3.Now quite rare
B. Assessment findings
1. Apprehension,
restlessness
2.Extremely high temperature (up to 1060 F[40.70C]), tachycardia, CHF, respiratory distress, delirium, coma
C. Nursing interventions
1.
Maintain a patient airway and adequate ventilation; administer oxygen as
ordered
2.Administer IV therapy as ordered
3.Administer medications as ordered: antithyroid
drugs, corticosteroids, sedatives, cardiac drugs